At the Global Fund Seventh Replenishment Conference last month, President Joe Biden pledged $6 billion in U.S. funding to fight AIDS, tuberculosis and malaria, and strengthen health systems worldwide. The announcement is a welcome sign of the administration’s continued interest in global health as attention to the COVID-19 pandemic wanes. But despite this and other recent commitments, the United States is still doing too little to address the danger of new and resurgent diseases.
The recent spread of monkeypox and even polio, though unlikely to reach pandemic levels, underscores this fact. Looking further, a paper published by Nature in April warned that there are more than 10,000 types of viruses that could infect humans currently circulating among wild animal populations, with the risk of “spillover” heightened by the effects of climate change. And perhaps worst of all, antibiotic-resistant bacteria — which already kill around 1 million people globally per year — could claim as many as 10 million lives annually by 2050, effectively returning us to a time when a simple cut could prove deadly.
COVID-19 itself has killed more than 1 million Americans, the highest official death toll in the world, and more than the combined total of Americans killed in wars since 1900.
A loss of life on this scale ought to bring about a reckoning, particularly in a country that was considered to be among the most prepared for a global pandemic prior to 2020. As the Washington Post editorial board stressed, this must include concerted domestic efforts to reform the nation’s public health systems and improve its response time to new pathogens.
Such a reckoning must also apply to the United States foreign policy and national security leaders. Pandemic disease is a prototypical transnational threat. New pathogens can arise anywhere; once they spread among the human population, containing them within the borders of a state is nearly impossible. This, as well as their catastrophic cost, suggests that American policymakers should make the prevention of future pandemics a core priority.
Yet the focus on this threat — and consequently, the funding to address it — remains disproportionately low. The Biden administration’s foreign policy rhetoric has centered instead on the struggle between democracies and autocracies, and U.S. competition with Russia and China in particular. Accordingly, the administration has requested an $813 billion budget for national defense in 2023.
Given Russia’s invasion of Ukraine and the accompanying increase in great power tensions, the administration’s emphasis on military threats is not surprising. But the United States already spends as much on its military as the next nine countries combined, most of which are U.S. allies. And Ukraine’s successful resistance against Russia, with ample U.S. aid, suggests that the conventional military threats from rivals may be more manageable than previously thought.
Nontraditional threats like pandemic disease are not yet treated with similar gravity. Fortunately — in addition to its recent pledge to the Global Fund — the Biden administration has offered some steps in the right direction. In its fiscal year 2023 budget request, the Biden administration called for an $88.2 billion investment in domestic and international pandemic preparedness. The administration has also proposed measures to strengthen the International Health Regulations to ensure rapid response to new disease outbreaks worldwide and has shepherded the creation of a new fund for global pandemic preparedness housed at the World Bank.
But the administration can do more. They should give top priority to managing antibiotic resistance. Earlier this year, the European Union banned the administration of antibiotics to healthy farm animals — a practice that accounts for as much as two-thirds of antibiotic use in the United States. Following the EU’s lead, the administration should seek to restrict this practice domestically, and should pursue an international agreement for the phaseout of this use of antibiotics worldwide, perhaps along the lines of prior agreements to progressively eliminate ozone depleting CFCs and HFCs in air conditioning.
The United States ought to also lead in funding the creation of new classes of antibiotics. Private companies have little incentive to develop new antibiotics, as they generally promise miniscule profit — and thus a new class of antibiotics has not been discovered in several decades. The administration could work, alone or with international partners, to put up funding for research and development and to keep the world one step ahead of antibiotic resistance.
Building on the success of Operation Warp Speed, the United States should subsidize even more ambitious vaccine development projects. This must include more durable and universal coronavirus vaccines, which government researchers are already developing even as they are in great need of further funding and resources. It could also work to accelerate the development and deployment of promising vaccines for HIV and malaria, both of which kill around half a million people per year.
Beyond just embracing these measures, the Biden administration should make them a centerpiece of its foreign policy. As members of Biden’s national security team recognized at the outset of his term, the world is increasingly beset by transnational threats that transcend traditional interstate security competition, pandemics and climate change foremost among them. Unlike the “democracies vs. autocracies” message, a robust effort to address these threats, starting with pandemics and antibiotic resistance, might actually be met with interest from the Global South — and could even be the basis for reviving some semblance of cooperation with China.
It is an error ingrained into the habits and structures of American government to prioritize military threats over all other dangers. But with millions of lives and staggering economic losses potentially at stake, it is an error we can no longer afford. The Biden administration has shown its willingness to take steps in the right direction — but for the sake of Americans and the world, they should go much further.
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ABOUT THE WRITER
Sam Fraser is an analyst at the Quincy Institute for Responsible Statecraft.
